Diabetes, End-of-life, Terminal Cancer
Conditions
Brief summary
Diabetes prevalence in palliative care is 10-15%. Most hospice patients are treated with insulin. The target glucose level is high in order to decrease the risk of hypoglycemia. Glucose level is usually monitored using capillary blood glucose once to three times daily. The aim of the research is to simplify this pattern of care in end-of-life patients. It will evaluate whether the non invasive measurement of glucose in urine could replace the measurement of capillary blood glucose. The first objective will be to assess the performance of the measurement of glucosuria using urinary dip stix to predict that the blood glucose level is within the target range. Due to the high glucose target, hyperglycemia is extremely frequent. However, symptoms of hyperglycemia are unfrequently reported. They may be unspecific and/or masked in end-of-life patients due to terminal disease and medication. The second objective of the study will be to define symptoms of hyperglycemia in these patients.
Detailed description
This is a prospective study involving several palliative care units in France. Glycemia and glycosuria will be measured in the same patients. Symptoms that could be related to hyperglycemia will be assessed in relation with the concomitant blood glucose level. Main investigations : Glycosuria and cetonuria will be measured using a dip stix during each nursing care. Glycemia will be measured before breakfast and before diner. Pain caused by finger pricking for the measurement of glycemia will be evaluated using a verbal scale. Symptoms will be evaluated at the time of each glucose measurement first with open questions then with a list of potential symptoms of hyperglycemia.
Interventions
OTHERdiagnosis
Measurement of glycosuria
Sponsors
Maison Médicale Jeanne Garnier
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* diabetic patients * hospitalised in a palliative care unit * terminally ill with cancer * with blood glucose measurement at least twice daily over 5 days * agreeing to participate in the study
Exclusion criteria
* patient unable to communicate, to understand information about the study or to decline participation in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Predictive performance of glycosuria measured on urine collected between 10 am and 16 am on the blood glucose level at 6 pm | over 12 days | Glycosuria will be assessed using Ketodiabur 5000 urinary dip stix. The results are semi-quantitative with 8 levels of glycosuria ranging from 0% to 2% (weight/volume). Capillary blood glucose level will be assessed using a glucose meter based on glucose oxydase. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Relation between glycemia and glycosuria at different time points over 24 hours. | over 12 days | Glycemia and glycosuria will be assessed as described above. |
| Intensity of pain caused by finger pricking | 12 days | Intensity of pain will be assessed using a simple numerical scale. |
| Type, frequency and intensity of symptoms in relation to the blood glucose level | 12 days | Intensity of symptoms will be assessed using a simple numerical scale. |
Contacts
Primary ContactMarie Francillard, MD
Outcome results
None listed